Health Equity Interventions Research Articles

Diabetes, chronic respiratory and cardiovascular diseases in Germany and Europe (EHIS-3 Survey)

Abstract Background We examined the prevalence of major NCD groups (diabetes, chronic respiratory diseases (CRD) and cardiovascular diseases (CVD)) as well as self-rated health (SRH) and health-related limitation in everyday activities among those with one of these NCD in Germany and Europe (average of 28 European countries (EU-28)). Methods Data was derived from the European Health Interview Survey (EHIS-3, 2019/20). Health indicators were: self-reported diabetes, CRD and CVD in the past 12 months; SRH (very good/good vs. fair, bad, very bad) and health-related limitations in usual everyday activities for at least 6 months (severe/moderate vs. no limitation). Educational level was operationalized via ISCED-11. Analyses are age-standardized to the European Standard Population 2013. Results Prevalence of major NCD in Germany were statistically significantly higher than in the EU-28: diabetes 8.1% vs. 7.1%, CRD 11.2% vs. 7.9% and CVD 6.6% vs. 5.4%. Highest prevalence was observed in the lowest educational group and lowest prevalence in the highest educational group for all of these NCD in Germany as well as in the EU-28. The proportion of a very good/good SRH among people having one of these NCD was higher in Germany compared to the EU-28: for people with diabetes 35.8% vs. 31.0%, with CRD 45.6% vs. 42.9% and with CVD 25.3% vs.19.1%. The proportion of health-related limitations among those having at least one of these NCD varied according to educational level in Germany as well as in the EU-28 with a higher prevalence among people with low educational level compared to high. Conclusions Even though prevalence of these NCD were higher in Germany, a higher proportion of very good/good SRH for people with one of these NCD was observed compared to the EU-28. Many factors such as severity of disease, disease management and care could explain this difference. Social inequalities were present not only in the prevalence of NCD but also in health-related limitations in Germany and Europe. Key messages • Prevalence of self-reported major NCD were higher in Germany while self-rated health among people having NCD was better than in Europe. • Health equity interventions in Germany and Europe are necessary.

Strategies to address common sleep disorders among middle-aged and older adults

Abstract Obstructive sleep apnea (OSA) is an underdiagnosed and prevalent condition in middle-aged and older adults, with a disproportionate burden of OSA in marginalized populations. Lack of appropriate and timely treatment puts many at risk of poor quality of life, comorbidity, motor vehicle crashes and increased health care utilization. Furthermore, social and environmental disparities were acknowledged as contributing to sleep health disparities, OSA health literacy and adherence to OSA treatment. This presentation will overview the social and environmental determinants of OSA prevalence and management. The presenter will also cover strategies to improve access and waiting time for OSA diagnosis and treatment in middle-aged and older adults, such as screening for OSA in general and marginalized populations, alternative at-home OSA detection solutions, involvement of alternative care providers in OSA care, alternative OSA targeted therapies, including accessible self-administered interventions, health equity interventions targeting OSA, and promotion of sleep-centered lifestyle approaches, including weight loss, diet and exercise.

Population-based physical activity promotion with a focus on health equity: evidence challenges

Abstract Issue Physical activity (PA) approaches that target the entire population hold great promise for public health particularly in terms of health equity due to their broad reach. During the process of developing national recommendations for PA and PA promotion in Germany, followed by a partial update, it became evident that there is limited evidence regarding population-based PA interventions with a focus on health equity. Our objective was to present an overview of the underlying reasons for this scarcity of evidence. Methods The methodology used in the development of the German recommendations to identify evidence for population-based health equity interventions was applied. Five scientific databases were searched for reviews published between 2015-2021. References of the included reviews were checked for additional reviews. Publications without any focus on health equity were not considered. The identified evidence was summarized narratively, followed by a description of existing challenges in evaluating. Results Our search yielded 4,411 reviews, of which 79 met the inclusion criteria but 75 were excluded because approaches did not focus on the whole population, or did not address health equity. Two reviews were found in the search for gray literature. Thus, the result is a total of 6 articles. None of these reviews reported the application of a theory. The consideration of quality criteria used before, during and after the practical implementation of interventions is not common. The complexity of population-based approaches proved to be a challenge. Conclusions Overall, there is a need for more emphasis on health equity in the implementation and evaluation of population-based PA approaches. The consideration of a theoretical underpinning of such complex approaches in complex systems and the application of standardised quality criteria are an important prerequisite for the generation of evidence. Key messages • There is little evidence of population-based PA approaches aimed at health equity. • A standardized and comprehensive evaluation assessment that is accepted by all public health stakeholders is needed.

A mixed-methods, theory-driven assessment of the sustainability of a multi-sectoral preventive intervention for South Asian Americans at risk for cardiovascular disease

BackgroundSouth Asian Americans bear a high burden of atherosclerotic cardiovascular disease (ASCVD), but little is known about the sustainability of evidence-based interventions (EBI) to prevent ASCVD in this population. Using community-based participatory research, we previously developed and implemented the South Asian Healthy Lifestyle Intervention (SAHELI), a culturally-adapted EBI targeting diet, physical activity, and stress management. In this study, we use the Integrated Sustainability Framework to investigate multisectoral partners’ perceptions of organizational factors influencing SAHELI sustainability and strategies for ensuring sustainability.MethodsFrom 2022 to 2023, we conducted a mixed-methods study (quant- > QUAL) with 17 SAHELI partners in the Chicago area. Partners’ settings included: community organization, school district, public health department, and healthcare system. Descriptive statistics summarized quantitative results. Two coders used a hybrid thematic analysis approach to identify qualitative themes. Qualitative and quantitative data were integrated and analyzed using mixed methods.ResultsSurveys (score range 1–5: higher scores indicate facilitators; lower scores indicate barriers) indicated SAHELI sustainability facilitators to be its “responsiveness to community values and needs” (mean = 4.9). Barriers were “financial support” (mean = 3.5), “infrastructure/capacity to support sustainment” (mean = 4.2), and “implementation leadership” (mean = 4.3). Qualitative findings confirmed quantitative findings that SAHELI provided culturally-tailored cardiovascular health education responsive to the needs of the South Asian American community, increased attention to health issues, and transformed perceptions of research among community members. Qualitative findings expanded upon quantitative findings, showing that the organizational fit of SAHELI was a facilitator to sustainability while competing priorities were barriers for partners from the public health department and health system. Partners from the public health department and health system discussed challenges in offering culturally-tailored programming exclusively for one targeted population. Sustainability strategies envisioned by partners included: transitioning SAHELI to a program delivered by community members; integrating components of SAHELI into other programs; and expanding SAHELI to other populations. Modifications made to SAHELI (i.e., virtual instead of in-person delivery) had both positive and negative implications for sustainability.DiscussionThis study identifies common sustainability barriers and facilitators across different sectors, as well as those specific to certain settings. Aligning health equity interventions with community needs and values, organizational activities, and local context and resources is critical for sustainability. Challenges also arise from balancing the needs of specific populations against providing programming for broader audiences.

Challenges and Opportunities for Participatory Evaluation of Local Public Health Efforts to Address Structural Racism and Advance Health Equity

This report describes the process of conducting a participatory evaluation of a local public health department and community partners’ joint efforts to address structural racism and advance health equity in Chicago, Illinois. The participatory evaluation is guided by a multi-partner advisory group composed of academic researchers and research assistants at a local public university; leadership and frontline staff at the local public health department; and individuals employed through local community-based organizations. This report details three key action points in the participatory evaluation process, highlighting the challenges and opportunities that arise while evaluating health equity interventions aimed at institutional and structural change. Insights gleaned from this process can inform ongoing and future participatory evaluation efforts and contribute to the establishment of best practices for partnering across institutions to reshape systems and power relationships to advance health equity.

A Scoping Review of Health Equity Interventions in Governmental Public Health.

Despite major efforts in research, practice, and policy, racial and ethnic disparities in health and health care persist in the United States. Interventions in collaboration with governmental public health may provide ways to address these persistent racial and ethnic health and health care disparities and improve health outcomes. To conduct a comprehensive review of health equity interventions performed in collaboration with public health agencies. This scoping review includes intervention studies from Ovid MEDLINE, PsycINFO, and Academic Search Premier, published between 2017 and 2023. The search strategy used terminology focused on 4 concepts: race/ethnicity, equity, health departments, and epidemiologic studies. The following inclusion criteria were determined a priori: (1) intervention tailored to reduce racial/ethnic health disparities, (2) public health department involvement, (3) health outcome measures, (4) use of epidemiologic study methods, (5) written in English, (6) implemented in the United States, (7) original data (not a commentary), and (8) published between January 2017 and January 2023. This review focused primarily on 4 dimensions of racial health equity interventions including intervention components, intervention settings, intervention delivery agents, and intervention outcomes. This review indicated that health equity interventions involving public health agencies focused on the following categories: (1) access to care, (2) health behavior, (3) infectious disease testing, (4) preventing transmission, and (5) cancer screening. Critical strategies included in interventions for reaching racial/ethnic minoritized people included using community settings, mobile clinics, social media/social networks, phone-based interventions, community-based workers, health education, active public health department involvement, and structural/policy change. This scoping review aims to provide an evidence map to inform public health agencies, researchers, and funding agencies on gaps in knowledge and priority areas for future research and to identify existing health equity interventions that could be considered for implementation by public health leaders.

Improving Indigenous health equity within the emergency department: a global review of interventions

IntroductionIndigenous health equity interventions situated within emergency care settings remain underexplored, despite their potential to influence patient care satisfaction and empowerment. This study aimed to systematically review and identify Indigenous equity interventions and their outcomes within acute care settings, which can potentially be utilized to improve equity within Canadian healthcare for Indigenous patients.MethodsA database search was completed of Medline, PubMed, Embase, Google Scholar, Scopus and CINAHL from inception to April 2023. For inclusion in the review, articles were interventional and encompassed program descriptions, evaluations, or theoretical frameworks within acute care settings for Indigenous patients. We evaluated the methodological quality using both the Joanna Briggs Institute checklist and the Ways Tried and True framework.ResultsOur literature search generated 122 publications. 11 articles were selected for full-text review, with five included in the final analysis. Two focusing on Canadian First Nations populations and three on Aboriginal Australians. The main intervention strategies included cultural safety training, integration of Indigenous knowledge into care models, optimizing waiting-room environments, and emphasizing sustainable evaluation methodologies. The quality of the interventions was varied, with the most promising studies including Indigenous perspectives and partnerships with local Indigenous organizations.ConclusionsAcute care settings, serving as the primary point of access to health care for many Indigenous populations, are well-positioned to implement health equity interventions such as cultural safety training, Indigenous knowledge integration, and optimization of waiting room environments, combined with sustainable evaluation methods. Participatory discussions with Indigenous communities are needed to advance this area of research and determine which interventions are relevant and appropriate for their local context.

Perspectives of community-based organizations on digital health equity interventions: a key informant interview study.

Health and healthcare are increasingly dependent on internet and digital solutions. Medically underserved communities that experience health disparities are often those who are burdened by digital disparities. While digital equity and digital health equity are national priorities, there is limited evidence about how community-based organizations (CBOs) consider and develop interventions. We conducted key informant interviews in 2022 purposively recruiting from health and welfare organizations engaged in digital equity work. Nineteen individuals from 13 organizations serving rural and/or urban communities from the local to national level participated in semi-structured interviews via Zoom regarding their perspectives on digital health equity interventions. Directed content analysis of verbatim interview transcripts was conducted to identify themes. Themes emerged at individual, organizational, and societal levels. Individual level themes included potential benefits from digital health equity, internet access challenges, and the need for access to devices and digital literacy. Organizational level themes included leveraging community assets, promising organizational practices and challenges. For the societal level, the shifting complexity of the digital equity ecosystem, policy issues, and data for needs assessment and evaluation were described. Several example case studies describing these themes were provided. Digital health equity interventions are complex, multi-level endeavors. Clear elucidation of the individual, organizational, and societal level factors that may impact digital health equity interventions are necessary to understanding if and how CBOs participate in such initiatives. This study presents unique perspectives directly from CBOs driving programs in this new arena of digital health equity.

Abstract 43: Race-Ethnic Specific Trends in Stroke Thrombolysis Care Metrics in Relation to U.S. Target: Stroke Nationwide Quality Improvement Program 2003-2021

Objectives: To examine whether thrombolysis care metrics have improved in all races and ethnicities with the launch and advance of Target: Stroke (TS) national quality initiatives. Methods: This cohort study included patients presenting to Get With The Guidelines (GWTG)-Stroke participating hospitals within 4.5 hours of ischemic stroke onset from 2003 to 2021. Thrombolysis rates and speed of treatment during TS phase I (2010-2013), II (2014-2018), and III (2019-2021) were compared with the pre-TS period (2003-2009). Results: Among all the patients with ischemic stroke, Asian, Black, and Hispanic individuals, compared with White, were significantly more likely to present after the 4.5-hour thrombolysis treatment window (Figure/Panel A and B). Among the 1,182,182 patients arriving within 4.5 hours, 33,375 were Asian, 180,315 Black, 86,831 Hispanic, and 881,661 White. Unadjusted rates of thrombolysis treatment increased in all race-ethnic groups from 2003 to 2021 (Figure/Panel C) with no significant disparities. Disparities were evident in adjusted analyses (Figure/Panel D) and persisted in TS:III when, compared with White patients, Asian, Black, and Hispanic patients had significantly lower odds of receiving thrombolysis (0.85, 0.76, and 0.86) (all p values<0.05). Door-to-needle (DTN) times significantly improved in all race-ethnic groups during TS (Figure/Panel E). However, compared with White patients, Asian, Black, and Hispanic patients had significantly lower odds of DTN≤60 minutes (Figure/Panel F) which persisted in TS:III (adjusted OR 0.91, 0.78, and 0.87) (all p values<0.05). Conclusion: Target: Stroke was associated with substantial improvement in thrombolysis frequency and timeliness for all races and ethnicities, but disparities persisted after risk adjustment. Further stroke system of care and health equity interventions should focus on early hospital arrival and quality reporting of risk-adjusted care metrics by race-ethnicity.

Understanding mechanisms of racial disparities in breast cancer: an assessment of screening and regular care in the Carolina Breast Cancer Study.

Screening history influences stage at detection, but regular preventive care may also influence breast tumor diagnostic characteristics. Few studies have evaluated healthcare utilization (both screening and primary care) in racially diverse screening-eligible populations. This analysis included 2,058 women age 45-74 (49% Black) from the Carolina Breast Cancer Study, a population-based cohort of women diagnosed with invasive breast cancer between 2008 and 2013. Screening history (threshold 0.5 mammograms per year) and pre-diagnostic healthcare utilization (i.e. regular care, based on responses to "During the past ten years, who did you usually see when you were sick or needed advice about your health?") were assessed as binary exposures. The relationship between healthcare utilization and tumor characteristics were evaluated overall and race-stratified. Among those lacking screening, Black participants had larger tumors (5 + cm) (frequency 19.6% vs 11.5%, relative frequency difference (RFD) = 8.1%, 95% CI 2.8-13.5), but race differences were attenuated among screening-adherent participants (10.2% vs 7.0%, RFD = 3.2%, 0.2-6.2). Similar trends were observed for tumor stage and mode of detection (mammogram vs lump). Among all participants, those lacking both screening and regular care had larger tumors (21% vs 8%, RR = 2.51, 1.76-3.56) and advanced (3B +) stage (19% vs 6%, RR = 3.15, 2.15-4.63) compared to the referent category (screening-adherent and regular care). Under-use of regular care and screening was more prevalent in socioeconomically disadvantaged areas of North Carolina. Access to regular care is an important safeguard for earlier detection. Our data suggest that health equity interventions should prioritize both primary care and screening.

Abstract A051: A conceptual framework for disclosure, intimacy, and sexual behaviors among Black women diagnosed with human papillomavirus

Abstract Purpose: Black women suffer disproportionately from Human papillomavirus (HPV) infection and related cancers, including greater associated post-diagnosis mortality. Little research and no frameworks, of which we are aware, have characterized the experiences of patients with a positive HPV diagnosis, including which factors contribute to disclosure of one’s HPV positive status, which has specific implications for intimacy with romantic partners, sexual behaviors, and the spread of HPV. Objective: To propose a conceptual framework regarding disclosure, intimacy with romantic partners, and sexual behaviors among Black women diagnosed with an HPV infection. Development: A working group including diverse perspectives in public health (e.g., infectious disease, women’s health, cancer health) conducted a review of eight existing public health, cancer health equity, and infectious diseases to identify frameworks relevant for our outcomes – i.e., communication about one’s disease status, partnership/relationship outcomes, and sexual health. Examples include Communication Privacy Management Theory, Politeness Theory, Objectification Theory, socioecological models, Maslow’s Hierarchy of Needs model, and models on social relationships and health, including those focused on stress processes. Framework: Our framework first characterizes HPV disclosure which is a multi-dimensional construct, representing the amount and type of information that is communicated to the partner. Multifaceted factors that contribute to disclosure include HPV knowledge, exposure to community stigma (e.g., sexual silence), self-efficacy for disclosure, and anticipated support from partner. These patient-level factors may not only contribute to disclosure, but also influence how HPV disclosure affects relationship outcomes (e.g., intimacy, sexual behaviors). Other theoretical moderators exist at multiple levels, including at the levels of the disclosure, partner, and relationship. At the level of the disclosure, the modality, amount, and type of information communicated may influence partner responsiveness and relationship outcomes (e.g., reduced intimacy, alternative sexual partners). At the partner level, knowledge of HPV, and exposure to community stigma can contribute to the partner’s response and relationship outcomes. At the relationship level, quality, values, and norms of the relationship, including trust, provision/receipt of emotional support, and communication norms, will also likely moderate the impact of disclosure on relationship outcomes. Emerging Research: This framework offers multiple venues for future cancer equity research. We will conduct participatory qualitative research to identify other relevant factors and pathways through which an HPV diagnosis may impact disclosure, intimacy, and subsequent sexual risk. We will subsequently conduct quantitative survey research to test associations and offer targets for future cancer health equity interventions. Citation Format: Barbara Williams, Kristine Zimmermann, Kathleen Kristensen, Kayla Moore, Whitney Miller, Elise Hu, Jamison Merrill, Marjorie Kersten, Lindsay Prescod, Uchechi Mitchell, Yamilé Molina. A conceptual framework for disclosure, intimacy, and sexual behaviors among Black women diagnosed with human papillomavirus [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr A051.

Racial disparities in treatment initiation between Black and White older adults with multiple myeloma: A SEER-Medicare analysis.

145 Background: We have previously identified racial disparities in multiple myeloma (MM) treatment initiation within 12 months of diagnosis. Black MM patients (60.6%) were significantly less likely to initiate treatment than White MM patients (69.5%). This current study aimed to explore the extent to which Black/White (B/W) disparities in MM treatment initiation were explained by differences in the distribution of demographic and health characteristics. Methods: We identified Black and White adults (66+) diagnosed with MM 2007 to 2017 in linked SEER-Medicare data. Patients were required to have 12 months of continuous Medicare Parts A and B pre- and post-diagnosis and Medicare Part D for 12 months post-diagnosis or until death. Our outcome was MM treatment initiation within 12 months of diagnosis and our independent variable was race (Black or White) as identified in SEER. Covariates thought to confound the relationship between race and MM treatment initiation were added to successive binomial regression models to estimate risk differences and 95% confidence limits (CL). Model 1 included only race. Model 2 added age and sex. Model 3 added Medicare low-income subsidy status and census tract poverty. Model 4 added rurality and SEER region. Model 5 added comorbidity and predicted frailty. Results: Our cohort (n=10,666) consisted of 1,649 Black and 9,017 White older adults with MM. Distributions of all individual, area-level and health characteristics differed significantly by race. In bivariate analysis all characteristics, except for sex and rurality, were significantly associated with treatment initiation. B/W risk differences remained significant across models and ranged from 3.7% (CL=0.9, 6.5) to 10.7% (CL=8.2, 13.2). Covariates explained some, but not all, of the B/W disparities in MM treatment initiation (Table 1). Conclusions: After accounting for differences in demographic and health characteristics, Black MM patients remained significantly less likely to initiate treatment within 12 months. Our study identified several factors that if addressed could attenuate B/W treatment initiation disparities. Further investigation is needed to understand how these factors contribute to treatment disparities, in order to develop health equity interventions to address them. Our results also suggest that there are additional unidentified factors contributing to disparity in MM treatment initiation. These factors must be identified and explored as we work to eliminate B/W disparities in MM treatment.[Table: see text]

Bidirectional processes linking social determinants of health and pediatric sickle cell anemia management: A qualitative study.

Children with sickle cell anemia (SCA) have substantial medical needs and more unmet basic needs than children with other medical conditions. Despite a recent focus on social determinants of health (SDoH), there remains an incomplete understanding of the processes linking SDoH and disease management, particularly for youth with SCA. This study elucidated these processes and identified ways to mitigate deleterious effects of adverse SDoH on SCA management. Parents/primary caregivers (N=27) of children with SCA (≤12 years old) participated in semi-structured interviews regarding SCA management and SDoH and completed quantitative measures of basic needs. Qualitative data were systematically coded and analyzed using applied thematic analysis. Quantitative data were presented descriptively. Three qualitative themes were identified. First, SCA management is bidirectionally linked with the social environment, whereby challenges of SCA management can hinder basic needs from being met, and unmet basic needs and financial hardship hinder SCA management. Second, due to limited resources, parents/caregivers are faced with difficult choices between prioritizing basic needs versus SCA management. Third, addressing material, emotional, and informational needs may improve SCA management. Quantitatively, 73% of families endorsed≥1 basic need, including food insecurity (42%), housing instability (62%), and/or energy insecurity 19% (vs. 20%). Despite documented associations, there remains a poor understanding of the processes linking SDoH and health. Findings underscore how day-to-day conditions undermine the management of SCA treatments, symptoms, and complications, limiting treatment effectiveness. Understanding these processes may inform family-centered, health equity interventions and policies to improve living conditions, disease management, and health outcomes.

Clinical algorithms, racism, and “fairness” in healthcare: A case of bounded justice

To date, attempts to address racially discriminatory clinical algorithms have largely focused on fairness and the development of models that “do no harm.” While the push for fairness is rooted in a desire to avoid or ameliorate health disparities, it generally neglects the role of racism in shaping health outcomes and does little to repair harm to patients. These limitations necessitate reconceptualizing how clinical algorithms should be designed and employed in pursuit of racial justice and health equity. A useful lens for this work is bounded justice, a concept and research analytic proposed by Melissa Creary to guide multidisciplinary health equity interventions. We describe how bounded justice offers a lens for (1) articulating the deep injustices embedded in the datasets, methodologies, and sociotechnical infrastructure underlying design and implementation of clinical algorithms and (2) envisioning how these algorithms can be redesigned to contribute to larger efforts that not only address current inequities, but to redress the historical mistreatment of communities of color by biomedical institutions. Thus, the aim of this article is two-fold. First, we apply the bounded justice analytic to fairness and clinical algorithms by describing structural constraints on health equity efforts such as medical device regulatory frameworks, race-based medicine, and racism in data. We then reimagine how clinical algorithms could function as a reparative technology to support justice and empower patients in the healthcare system.

Feasibility of the Poverty-Targeted Pediatric Cancer Resource Equity (PediCARE) intervention.

10009 Background: Children with cancer living in poverty are more likely to relapse and die, even when treated uniformly on clinical trials. No evidence-based interventions targeting poverty as a risk factor for disparate outcomes exist in pediatric oncology. We previously developed and refined the Pediatric Cancer Resource Equity (PediCARE) intervention—a centrally-delivered, household material hardship (HMH)-targeted intervention that provides transportation and groceries to low-income pediatric oncology families. We report feasibility of administering PediCARE as a randomized intervention across 2-centers. Methods: We conducted a pilot randomized controlled trial (RCT) of PediCARE versus usual care at Dana-Farber Cancer Institute (DFCI) and University of Alabama Birmingham (UAB) between May 2019 and August 2021 (NCT03638453). Eligible participants included children age < 18 years with de novo cancer diagnosed in the prior 2-months, who were planned to receive at least 4-cycles of chemotherapy and lived in a household that screened positive for HMH (food, housing, utility or transportation insecurity). Participants were randomized 1:1 by site to receive PediCARE or usual care for 6-months. Parent/guardians completed a household survey at baseline and at completion of the 6-month intervention. The primary outcome was feasibility defined a priori as a recruitment and consent to randomization rate of > = 75% and < 20% attrition per arm—endpoints intended to justify the feasibility of a subsequent efficacy RCT. Secondary outcomes included proportion of recipients who successfully received the intervention and intervention acceptability. Results: A total of N = 40/40 eligible families (n = 12 UAB; n = 28 DFCI) were approached and offered an opportunity to participate (100% consent rate). Among participants, there was 0% attrition in either arm following randomization and the 6-month intervention period; 100% of parent/guardians completed both baseline and 6-month surveys. Among those randomized to PediCARE, 100% (n = 20) successfully received grocery and transportation resources; 100% reported that it was "easier to buy food for my family," 85% reported it was easier to get to and from the hospital, and 95% reported they would be “very likely to recommend the intervention to other families”. Conclusions: Stark disparities exist in pediatric oncology. Advancement in health equity science must include establishment of a robust, evidence-based portfolio of scalable health equity interventions for evaluation in the Children’s Oncology Group (COG) drug trial setting. Findings from this pilot RCT support feasibility and utility of a poverty-targeted intervention from the clinical oncology setting—as evidenced by 100% of parent/guardians consenting to randomization with 0% attrition across 2-centers. Immediate next steps include randomized efficacy evaluation in a COG trial-embedded study. Clinical trial information: NCT03638453 .

Socioeconomic Disparities in Adolescents' Caries Prevalence

Introduction: Policymakers and academics have explored the behavioral approach in their attempts to explain and address the socioeconomic disparities in adolescents' oral health. However, evidence regarding this issue is scarce in the Korean adolescent population. This study aimed to examine whether socioeconomic status is associated with dental caries and whether oral health-related behaviors (OHRBs) explain or moderate the hypothesized association in Korean adolescents. Methods: A secondary analysis was conducted using the Korea National Health and Nutrition Examination Survey data from 2016 to 2019. Adolescents (n = 1062) aged 13–18 years were included in the analysis. The association between income and untreated decayed permanent teeth (DT) was investigated, focusing on the intermediary roles of OHRBs, using hierarchical negative binomial regression models. Results: Higher income (incidence rate ratio [IRR] 0.70, P < 0.001), regular breakfast intake (IRR 0.64, P < 0.001), higher fruit and vegetable consumption (IRR 0.93, P < 0.001), preventive dental check-ups (IRR 0.84, P < 0.001), and frequent toothbrushing (IRR 0.73, P < 0.001) were associated with lower DT. The income-DT association remained significant and its magnitude was only slightly attenuated, after adjusting for OHRBs (IRR 0.74, P < 0.001). Significant interaction effects were found between income and each OHRB on DT (all with P < 0.001), and interaction patterns differed by behavior type: The income-DT association was stronger in the presence of unfavorable dietary-and favorable dental care-behaviors. Conclusion: The study findings suggested that adolescent oral health equity interventions should prioritize the structural approach and give more thorough consideration to the interactions between socioeconomic and behavioral factors.

Examining Indigenous emergency care equity projects: a scoping review protocol

IntroductionIndigenous peoples across the globe face inequitable access to high-quality care. Emergency departments are the first point of access for many Indigenous peoples and are the interface between the individual...

Rates of unplanned hospital care in Black Americans with pancreatic cancer.

666 Background: Individuals with cancer are more likely to visit an emergency department (ED) for issues both related and unrelated to their cancer than individuals without cancer, but data are lacking regarding what subpopulations are most vulnerable. Here, we assessed the characteristics of patients with pancreas cancer across the Northwell Health system who had multiple ED visits. Methods: An IRB-approved retrospective chart review of patients with pancreas cancer diagnosed between 2015 through 2021 was conducted. Patients with > 3 ED visits were defined as high utilization and patients with 0 ED visits were defined as low utilization. Demographic and clinical features were recorded. Median income was extrapolated by zip code using data from the US Census Bureau. Generalized logistic regression models were constructed to analyze characteristics associated with high ED utilization. Results: The cohort consisted of 658 patients, among whom 181 individuals met criteria for high utilization and 140 met criteria for low utilization. Stage, age, gender, ethnicity, history of pancreatitis, median income, preferred language, establishment with primary care provider, and establishment with medical oncologist had no significant association with high utilization. Race (OR: 2.8; p = 0.002) and substance abuse (OR: 4.43; p = 0.02) were the strongest predictors of high ED utilization. We observed that 14% of the individuals who were Black had a history of substance abuse. Conclusions: Our analysis identified a striking and concerning association between high utilization of the ED and patients who are Black or who have a history of substance abuse. Substance abuse may contribute to high ED utilization among Black Americans, however, 86% had no history of substance abuse, suggesting that other causal factors are at play. These results compel further investigation into these casual factors to guide the development of health equity interventions to address these disparities.[Table: see text]

How psychologists can help achieve equity in health care-advancing innovative partnerships and models of care delivery: Introduction to the special issue.

For as long as the United States has been a country, the distribution of good health has been unequal. In this special issue, we consider what psychology can do to understand and ameliorate these inequalities. The introduction sets the context for why psychologists are well positioned, well trained, and needed to champion health equity via innovative partnerships and models of care delivery. A guide is provided for engaging and maintaining a health equity lens in advocacy, research, education/training, and practice efforts for psychologists, and readers are invited to apply a health equity lens to reimagine their existing and forthcoming work. More broadly, the special issue brings together a collection of 14 articles across three core themes: (a) integration of care, (b) intersections between social drivers/determinants of health, and (c) intersecting social systems. The articles collectively highlight the need for new conceptual models to guide research, education, and practice, the importance of engaging in transdisciplinary partnerships, and the urgency of collaborating with community members in cross-system alliances to tackle social drivers of health, structural racism, and contextual risks, all of which are fundamental drivers of health inequity. Although psychologists are uniquely positioned to investigate causes of inequality, develop health equity interventions, and advocate for policy changes, our voice and vision have been missing from broader national dialogues around these issues. This issue is poised to provide examples of existing equity work and inspire ALL psychologists to engage for the first time or deepen existing health equity work with renewed vigor and reimagined possibilities. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Abstract B096: Food insecurity and receipt of Supplemental Nutrition Assistance Program (SNAP) benefits among income-eligible US pediatric acute lymphoblastic leukemia patients enrolled on a multi-center clinical trial

Abstract Background Food insecurity (FI) is an adverse social determinant of health (SDoH) prevalent among pediatric cancer patients and associated with poorer health outcomes in general pediatrics. Receipt of federal SNAP benefits reduces FI in general pediatrics, and is thus a marker of appropriate resource support to mitigate adverse SDoH. Dana-Farber Cancer Institute (DFCI) Acute Lymphoblastic Leukemia (ALL) Consortium Trial 16-001 is the first pediatric oncology clinical trial to prospectively collect parent-reported SDoH, including income, SNAP receipt, and FI. We investigated whether income-eligible pediatric ALL families were successfully receiving SNAP benefits, and whether SNAP receipt was associated with FI. Methods Secondary analysis of children aged 1-17 years with de novo ALL enrolled on the DFCI 16-001-embedded SDoH cohort study at 6 US centers from 2017-2022. We utilized parent-reported SDoH data at diagnosis (T0) and 6-mos (T1) into therapy to identify families as (1) SNAP-eligible, proxied as household income <130% Federal Poverty Level based on federal guidelines; and (2) food insecure, based on validated 2-item screen. McNemar’s test compared SNAP receipt at T0 vs T1 among those eligible at both timepoints. Associations between SNAP eligibility, SNAP receipt, and FI were evaluated with chi-square tests. Results At T0, among 262 evaluable families, 21% reported FI. A total of 20% (n=53) were SNAP-eligible, of whom 60% (n=32) reported FI and 53% (n=28) were receiving SNAP. Among 28 SNAP-recipient families, 61% reported FI. Similarly, at T1, among 223 evaluable families, 25% reported FI. A total of 28% (n=62) were SNAP-eligible, of whom 58% (n=36) reported FI and 58% (n=36) were receiving SNAP. Among 36 SNAP-recipient families, 56% reported FI. A significantly higher proportion of the 33 families SNAP-eligible at both T0 and T1 were receiving SNAP at T1 (70%) compared to T0 (52%) (p=0.034). Among eligible families, SNAP receipt was not associated with lower odds of FI at T0 (OR 1.03, p=0.96) or T1 (OR 0.83, p=0.73). Discussion FI, a well-defined adverse SDoH associated with inferior health outcomes, is highly prevalent among a trial-enrolled pediatric ALL population. Despite care delivery at highly resourced centers with dedicated staff to address social needs, a substantial proportion of likely eligible families (as proxied by income) were not receiving SNAP benefits 6-mos into therapy. Further, receipt of SNAP was inadequate to ameliorate FI in this cohort, with ~60% of SNAP recipients reporting concurrent FI both at T0 and T1. Ensuring successful connection of eligible families to existing benefits is an essential first step. However, high rates of FI among SNAP recipients indicate that resource navigation, though necessary, is not sufficient to address FI for this population. These data provide immediate targets for health equity interventions—including systematic benefits navigation, direct resource provision, and policy-based approaches for benefits augmentation—to address adverse SDoH and improve cancer outcomes. Citation Format: Rahela Aziz-Bose, Yael Flamand, Puja J. Umaretiya, Lenka Ilcisin, Ariana Valenzuela, Peter D. Cole, Lisa M. Gennarini, Justine M. Kahn, Kara M. Kelly, Bruno Michon, Thai-Hoa Tran, Jennifer J. G. Welch, Lewis B. Silverman, Kira Bona. Food insecurity and receipt of Supplemental Nutrition Assistance Program (SNAP) benefits among income-eligible US pediatric acute lymphoblastic leukemia patients enrolled on a multi-center clinical trial [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr B096.